BILL NUMBER: AB 2747 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 24, 2008
AMENDED IN ASSEMBLY APRIL 7, 2008
AMENDED IN ASSEMBLY MARCH 25, 2008
INTRODUCED BY Assembly Members Berg and Levine
( Coauthors: Assembly Members
Bass, Jones, Mullin, Salas,
Torrico, and Wolk )
FEBRUARY 22, 2008
An act to add Part 1.8 (commencing with Section 442) to Division 1
of the Health and Safety Code, relating to end-of-life care.
LEGISLATIVE COUNSEL'S DIGEST
AB 2747, as amended, Berg. End-of-life care.
Existing law provides for the licensure and regulation of health
facilities and hospices by the State Department of Public Health.
Existing law provides for the regulation and licensing of physicians
and surgeons by the Medical Board of California.
This bill would provide that when an attending physician
a health care provider, as defined, makes a
diagnosis that a patient has a terminal illness or makes a prognosis
that a patient has less than one year to live, the health care
provider shall , upon the patient's request, provide the
patient with the opportunity to receive
information and counseling regarding legal end-of-life options, as
specified, and provide for the referral or transfer of a patient if
the patient's physician health care provider
does not wish to comply with the patient's choice of
end-of-life options.
Vote: majority. Appropriation: no. Fiscal committee: no.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Palliative and hospice care are invaluable resources for
terminally ill Californians in need of comfort and support at the end
of life.
(b) Palliative care and conventional medical treatment should be
thoroughly integrated rather than viewed as separate entities.
(c) Even though Californians with a prognosis of six months or
less to live are eligible for hospice care, nearly two-thirds of them
receive hospice services for less than one month.
(d) Many patients benefit from being referred to hospice care
earlier, where they receive better pain and symptom management and
have an improved quality of life.
(e) Significant information gaps may exist between health care
providers and their patients on end-of-life care options potentially
leading to delays to, or lack of, referrals to hospice care for
terminally ill patients. The sharing of important information
regarding specific treatment options in a timely manner by health
care providers is a key component of quality end-of-life care.
Information that is helpful to patients and their families includes,
but is not limited to, the availability of hospice care, the efficacy
and potential side effects of continued curative treatment, and
withholding or withdrawal of life-sustaining treatments.
(f) Terminally ill and dying patients rely on their health care
providers to give them timely and informative data. Research shows a
lack of communication between health care providers and their
terminally ill patients can cause problems, including poor
availability of, and lack of clarity regarding, advanced health care
directives and patients' end-of-life care preferences. This lack of
information and poor adherence to patient choices result in "bad
deaths" that cause needless physical and psychological suffering to
patients and their families.
(g) Those problems are complicated by social issues, such as
cultural and religious pressures for the providers, patients, and
their family members. A recent survey found that providers that
object to certain practices are less likely than others to believe
they have an obligation to present all of the options to patients and
refer patients to other providers, if necessary.
(h) Every medical school in California is required to include
end-of-life care issues in its curriculum and every physician in
California is required to complete continuing education courses in
end-of-life care.
(i) Palliative care is not a one-size-fits-all approach. Patients
have a range of diseases and respond differently to treatment
options. A key benefit of palliative care is that it customizes
treatment to meet the needs of each individual person.
(j) Informed patient choices will help terminally ill patients and
their families cope with one of life's most challenging situations.
SEC. 2. Part 1.8 (commencing with Section 442) is added to
Division 1 of the Health and Safety Code, to read:
PART 1.8. End-Of-Life Care
442. For the purposes of this part, the following definitions
shall apply:
(a) "Curative treatment" means treatment intended to cure or
alleviate symptoms of a given disease or condition.
(b) "Health care provider" means an attending physician and
surgeon, nurse practitioner, or physician assistant.
(b)
(c) "Hospice" means a specialized form of
interdisciplinary health care that is designed to provide palliative
care, alleviate the physical, emotional, social, and spiritual
discomforts of an individual who is experiencing the last phases of
life due to the existence of a terminal disease, and provide
supportive care to the primary caregiver and the family of the
hospice patient, and that meets all of the criteria specified in
subdivision (b) of Section 1746.
(c)
(d) "Palliative care" means medical treatment,
interdisciplinary care, or consultation provided to a patient or
family members, or both, that has as its primary purpose the
prevention of, or relief from, suffering and the enhancement of the
quality of life, rather than treatment aimed at investigation and
intervention for the purpose of cure or prolongation of life as
described in subdivision (b) of Section 1339.31.
(d)
(e) "Palliative sedation" means the use of sedative
medications to relieve extreme suffering by making the patient
unaware and unconscious, while artificial food and hydration
are withheld, during the progression of the disease leading to the
death of the patient. and in some cases,
involves the withholding of artificial food and hydration. A patients
death however, is caused by his or her disease processes and his or
her complications, and not from palliative sedation.
(e)
(f) "Refusal or withdrawal of life sustaining
life-sustaining treatment" means forgoing
treatment or medical procedures that replace or support an essential
bodily function, including, but not limited to, cardiopulmonary
resuscitation, mechanical ventilation, artificial nutrition and
hydration, dialysis, and any other treatment or discontinuing any or
all of those treatments after they have been used for a reasonable
time.
(f)
(g) "Voluntary stopping of eating and drinking" or
"VSED" means the voluntary refusal of a patient
patient's choice to voluntarily refuse to eat and drink in
order to alleviate his or her suffering, and includes the
withholding or withdrawal of life-sustaining treatment at the request
of the patient.
442.5. When an attending physician health
care provider makes a diagnosis that a patient has a terminal
illness or makes a prognosis that a patient has less than one year to
live, the physician health care provider
shall , upon the patient's request, provide the
patient with the opportunity to receive
comprehensive information and counseling regarding legal end-of-life
care options. When a patient is in a health facility, as defined in
Section 1250, the attending physician health
care provider or medical director may refer the patient to a
hospice provider or private or public agencies and community-based
organizations that specialize in end-of-life care case management and
consultation to receive information and counseling regarding legal
end-of-life care options.
(a) If the patient indicates a desire to receive the information
and counseling, the information shall include, but not be limited to,
the following:
(1) Hospice care at home or in a health care setting.
(2) A prognosis with and without the continuation of curative
treatment.
(3) The patient's right to refusal of or withdrawal from
life-sustaining treatment.
(4) The patient's right to continue to pursue curative treatment
while receiving palliative care.
(5) The patient's right to comprehensive pain and symptom
management at the end of life, including, but not limited to,
adequate pain medication, treatment of nausea, palliative
chemotherapy, relief of shortness of breath and fatigue, VSED, and
palliative sedation.
(b) The information described in subdivision (a) may, but is not
required to be, in writing. Health care providers may utilize
information from organizations specializing in end-of-life care that
provide information on fact sheets and Internet Web sites to convey
the information described in subdivision (a).
(c) Counseling may include, but not be limited to, discussions
about the outcomes on the patient and his or her family, based on the
interest of the patient. These discussions may occur over a
series of meetings with the health care provider or others who may be
providing the counseling based on the patient's needs.
442.7. If a physician healt h
care provider does not wish to comply with his or her patient's
choice of end-of-life options, the health care provider shall do
both of the following:
(a) Refer or transfer a patient to an alternative
another health care provider.
(b) Provide the patient with information on procedures to transfer
to an alternative another health care
provider.